A major challenge for clinicians, pharmaceutical companies and regulatory agencies is to better understand the relative contributions of ontogeny and genetic variation to observed variability in drug disposition and response across the pediatric age spectrum from pre-term and term newborns, to infants, children and adolescents. Knowledge of the contribution of genetic variation to variability in drug disposition and response in adults has increased substantially over the past 25 years, but the application of pharmacogenetic and pharmacogenomic principles to pediatric drug therapy has lagged well behind. Extrapolation of adult experience with pharmacogenomics and personalized medicine to pediatric patients of different ages and developmental stages is fraught with many challenges. Some pediatric diseases have no adult correlate or are more prevalent in children compared to adults. Likewise, several adverse drug reactions are unique to children or occur at a higher frequency in children. Compared to adults, pediatric pharmacogenetics and pharmacogenomics involves an added measure of complexity as variability due to developmental processes,or ontogeny, is superimposed upon genetic variation. In the context of drug disposition and response, the additional complexity that ontogeny contributes manifests as unanticipated differences in dosing requirements, drug efficacy or risk of toxicity relative to what is expected based on experience in adults. The primary objective of this proposal is to continue an ongoing series of annual conferences on Pediatric Pharmacogenomics and Personalized Medicine organized by the Center for Personalized Medicine and Therapeutic Innovation and Division of Clinical Pharmacology and Medical Therapeutics at Children's Mercy Hospitals and Clinics in Kansas City, MO. The goals of the meeting are 1) To bring together clinicians, basic and translational scientists and allied healthcare practitioners, and engage in multi- and cross-disciplinary dialogue aimed at implementing personalized medicine in pediatric settings; 2) To provide a forum for the presentation and dissemination of research related to the application of pharmacogenomic strategies to investigations of variability of drug disposition and response in children; 3) To explore the ethical, legal and societal implications of pharmacogenomics and personalized medicine that are unique to children; and 4) To create networking opportunities for stimulating discussion, cooperation and collaboration to devise strategies to address research needs identified. Ultimately, the goal of this program is to improve the safety and efficacy of medications in children of all ages.